Cause of true leg length shortening
Fractured NOF Hip dislocation Growth disturbance of tibia/fibula e.g osteomyelitis or fracture Surgery e.g. Total hip replacement SUFE Perthes
Cause of apparent shortening of leg
Scoliosis of the spine
Feature of OA in hip
Pain
Stiffness
Trendelenburg gait or positive trendenlburg test
Decreased range of motion - especially internal rotation
Fixed flexion deformity
Definition of osteoarthritis
Degenerative joint disorder in which there is progressive loss of hyaline cartilage and new bone formation at the joint surface and its margin
Risk of posterior approach - hip athroplasty
Higher dislocation rates than anterolateral Injury to sciatic nerve - foot drop
Complication of anterolateral approach - hip athroplasty
Injury to superior gluteal nerve - trendenlburg gait
Knee locking differential
Meniscal tear
Crucible ligament injury
Osteochondritis dissecans: adolescents Loose body
Surgical management of ACL repair
Autograft repair - classically using semitendonous and gracillis
Aietology of hallux valgus
Familial tendency Increased enclosed and pointed shoes
Associated with rheumatoid athritis
Surgical management of hallux valgus
Bunionectomy
1st metatarsal reallimgement surgery
Excision athroplasty
Definition of Charcot joints
Progressive destructive joint athropathy secondary to disturbance of the sensory innervation to the joint. It results in a painless deformed joint resulting from repatitive minor trauma
Cause of Charcot joints
Peripheral: DM, peripheral never Injury, leprosy
Central: syringomyelia, tabes dorsalis
Definition of a bakers cyst
Posterior herniation of knee joint capsule
Cause of winging of the scapula
Long thoracic nerve damage
Upper brachial plexus injury
Muscular dystrophy
Froment test
Flexion of thumb at IPJ - weak adductor policis Indicates ulnar nerve lesion
Contents of the carpal tunnel
4 tendon of FDS
4 tendon of FDP
1 tendon of flexor palmaris longus
Median nerve
Muscle in hands innervates by median nerve
Lateral two lumbricals
Oppens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
Cause of a positive trendelenburg test
Abductor wasting secondary to chronic pain
Superior gluteal nerve injury
Structural - developmental dysplasia of the hip
Cause of an ulnar palsy
Anatomical compression - cubital tunnel syndrome at elbow - guyons canal syndrome at wrist
Trauma - supracondylar fracture of the humerus - elbow dislocation
Ulnar pardox
Proximal lesion lead to paralysis of ulnar half of FDP which leads to less wasting
Feature of ulnar nerve palsy
Partial claw hand - little and ring fingers
Weak abduction and adduction of fingers
Weak flexion of DIPJ in little and ring finger
Wasting: hypothenar emminance, dorsal interossei
Indication for surgical management of lumbar disc herniation
Progressive neurological defecit
Severe incapacitating pain
Failing of non surgical management
Risk factors for OA
Age
Obesity
Joint abnormality
Physical/manual occupation
Definition of athrodesis
Artificial induction of joint ossification between two bones by surgery
Risk factor for septic athritis
Joint diesease
Chronic renal failure
Immunosupresion e.g DM
prosthetic joints
Comlications of septic athritis
Sepsis Osteomyelitis Athritis Ankylosis - fusion
Risk factors for osteoporosis
SHATTERED Steroids Hyperthyroid, Hyperparathyroidism, HIV Alcohol and cigarettes Thin - BMI Testosterone decrease Early menopause Renal or liver failure Erosive/inflammatory bone disease Dietary Ca decrease/malabsorption, DM
Indication for a DEXA scan
Low trauma fracture
Women > 65 with one or more risk factor
Before giving long term steroids
Parathyroid disorders, myeloma, HIV
Intepretation of T scores produced from a DEXA scan
T>-1 = normal
T: -1 to -2.5 = osteopenia
T:
Osteoporotic fractures
Vertebral collapse neck of femur
Neck of humerus
Colles
Definition of a sublaxation
Normal anatomy of the joint is disrupted but there remain some contact between the articualar surfaces of the joint
Definition of dislocation
Complete disruption of the joint with no contact between joint surfaces
Clincal sign of a fracture
Pain Swelling Crepitus Deformity Adjacent structural injury: nerves ligaments, vessel, tendon
Complication of fractures
Immediate - neurovascular complications - visceral damage
Early- compartment syndrome - infection - fat embolism
Late - problems with union - Avascular necrosis - growth disturbances - post traumatic OA - complex regional pain syndrome- myosotis ossificans- reflex sympathetic dystrophy
Complication of a Colles fracture
Median nerve injury Frozen shoulder/adhesive capuslitis Tendon rupture - EPL Carpal tunnel syndrome Mal/non-Union Complex regional pain syndrome
What is a dinner fork deformity
Dorsally displaced and angulated with shortening of the radius
Smiths fracture
Fracture of the distal radius with volar displacement and angulation of the distal fragment
Barron’s fracture
Oblique intra-articular fracture involving the dorsal aspect of the distal radius and dislocation of the radio-ulnar joint
Monteggia fracture
Fracture of the proximal 1/3 of the ulna shaft with anterior dislocation of the radial head of the capiteleum
Galleazi fracture
Fracture of radial shaft between mid and distal 1/3
Bankart lesions
Damage to anteroinferior glenoid labrum following shoulder dislocation
Hill-Sachs lesion
Cortical depression in the posterolateral part of the humeral head following impaction against the glenoid rim during anterior dislocation
Complication of shoulder dislocations
Recurrent dislocation Axillary nerve damage Brachial plexus injury Axillary artery damage Associated fracture
Muscles of the rotator cuff and test
- Supraspinatus - jobes test
- Infraspinatus - external rotation
- Subscapularis - gerber lift of test
- Teres minor - external rotation
Impingement syndrome
Entrapment of supraspinatus tendon and subacromial bursa between acromion and greater tuberosity of the humerus
Unhappy triad of O’donoghue
ACL
MCL
Medial meniscus
Spinal fractures
- Anterior wedge # - loss of vetebral body
- Burst # - axial compression of spine (unstable)
- Chance # - transverse # across L2/3
- L2# - unstable
- Jefferson #
Definition of Dupuytrens contracture
Progressive, painless, fibrotic thickening of palmar fascia